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Gibson Mhaka, Senior Reporter

THE story of a mentally-challenged mum who gave birth before the baby fell into a toilet bowl and died at Mpilo Central Hospital in Bulawayo as a result of a suspected negligence by nurses made sad reading.

This was after nurses allegedly left the 21-year-old mentally challenged mother to give birth unattended.

The horrific incident happened on 30 December 2021 after the woman from Nkulumane 12 who was allegedly denied attentive care supposedly as a result of her mental disability went into labour and decided to use the toilet where her baby was later trapped in the bowl.

Her brother Lindelwe Maduma described the incident as “gross negligence”.

“According to some expecting mothers who were with her, she started experiencing extreme labour pains at around 3AM.

“While writhing in pain she screamed for help, but no one came to assist her. At around 5AM, when the pain became unbearable, she then got out of bed and went to the toilet. While she was there trying to relieve herself, that’s when the baby came out and it fell into the toilet bowl,” said Lindelwe while struggling to hold back his tears.

This sad incident is a reflection that although women with disabilities may face unique challenges when it comes to pregnancy care, those who are mentally challenged have largely been ignored when it comes to accessing maternal health care services and reproductive health care. They are often thought not to be sexually active, and less likely to marry or to have children than other women with disabilities.

These beliefs may come from perceptions that women with disabilities are either ‘‘passive receivers of help’’ or ‘‘patients’’ not capable of marriage or giving birth.

According to new mortality estimates recently released by Unicef, the World Health Organisation (WHO), the United Nations Population Division, UNFPA and the World Bank Group, an estimated 2,8 million pregnant women and newborns die every year, or one in every 11 seconds, mostly because of preventable causes.

Although Zimbabwe like every Southern African Development Community (Sadc) state made regional and national commitments to at least have maternal deaths or to ensure the rate is 70 per 100 000 births by 2030 as spelt by the Sustainable Development Goals (SDGs), it is important to note that the intersection between mental illness, and maternal healthcare has not merited much attention in Zimbabwe.

While there has been a spate of progressive programmes delivered by the Ministry of Health and Child Care in recent times recognising the right to reproductive choice of women with disabilities, the programmes unfortunately have not engaged much with the question of the reproductive rights of women with mental illness.

This is despite the fact that one of the most comprehensive statements of the rights of persons with mental illness is in the United Nations Principles for the Protection of Persons with Mental Illness and the Improvement in Mental Health Care, 1991.

Laying emphasis on the 1991 principles, WHO articulated 10 basic principles of mental health care law.

One of the most significant principles, is that there should be no discrimination on the grounds of mental illness and that all persons with mental illness have the same rights to medical and social care as others.

Mental health activist Miss Zenani Masuku who is also executive director of African Institute for Ending Bullying, Depression and Suicide (Afribis) said women with mental illness encounter negative attitudes about pregnancy and parenting from many sources, including their family members, healthcare providers and the general public.

“Specific needs of women with mental illness are unlikely to be addressed in mainstream pregnancy and parenting information sources, like books, magazines, and popular mobile applications. Government needs to integrate maternal mental health into primary health care so that women with mental illness will be supported before, during, and following their pregnancies,” said Miss Masuku.

It is important to note that although the government advises women to give birth in health facilities, demographic data indicates mentally-challenged mothers experienced significant challenges with regard to accessibility of healthcare and support before, during, and following their pregnancies.

Multiple studies from low- and middle-income countries have found that women with mental illness feel the desire for motherhood as much as women without special clinical needs. Their fertility is often not impacted by disability and they can have children.

Another mental health activist Ms Gamuchirai Chinamasa said women with mental health problems face additional disadvantages compared with women with other forms of disability as they were discriminated against because of their gender as well as their disability.

 “Women with mental illness have a higher risk of adverse pregnancy outcome and should be considered a risk group. More knowledge and outreach programmes and training of health workers on what mental health is and the care that can be offered to manage common mental health problems are extensively needed to minimise the health risks of women with mental problems. 

“There is also a need for funding for those that cannot afford it. Lack of knowledge means that most of the time they don’t know the indicators of the problem and how to assist the victims on when and where they can seek help,” said Ms Chinamasa.

According to mental health specialist Dr Mazvita Machinga women with mental illness were not being fully supported during pregnancy and their reproductive rights were also not fully integrated in the country’s health programmes.

She said healthcare providers are not often trained to provide reproductive care to women with mental illness.

 “There are no clinicians who are trained to work to respond to the needs of such population and my experience has seen that nurses and even doctors do not have adequate training on helping women it’s only psychiatric health care workers who are supposed to help and many times they are not in most health care settings with such kind of people.

“This is because these women often do not have loved ones who help them or who commit to help them and there is a stigma towards mentally ill and when they are not taking their medication.

“Families do not take them seriously hence their needs are not often met.

“Sometimes they miss their appointments. They do not have knowledge or are not aware that they need the care. The issue of stigma towards mental illnesses makes them get no help,” said Dr Machinga.

She said providers that do have specialised training may not be located near all women with mental illness who need their services.

On what should be done to address those challenges Dr Machinga said: “There is a need to deal with the issue of stigma to enlighten the society on mental health issues.

“There is a need to mainstream mental health literacy in all maternal care programmes so that nurses and doctors and others learn how to respond. Educating families on how to journey with their loved one when they are pregnant

“Mental illness is broad. I think people only think of schizophrenia but when we talk of mental disorders we talk of depression, anxiety, substance use disorder, Post-Traumatic Stress Disorder (PTSD) and others all these can affect access to care so it’s important that women be educated and maybe an assessment of their needs be done”.

From her observation it is clear that exclusion of women particularly those with mental illness in public health programmes and services remains a neglected and an unresolved public health and human rights challenge in developing countries like Zimbabwe.

Evidently, there is a need to address the neglect of mental health advocacy at multiple levels to make sure that the issue also moves up on the political agenda.

Mental health advocates need to stress that government budgets provide adequate funding to cover the need for mental health services in the country.